Provider Demographics
NPI:1821975509
Name:PASA, MATTHEW (FP-C, CCP-C, PM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PASA
Suffix:
Gender:M
Credentials:FP-C, CCP-C, PM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 SE PASCAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6760
Mailing Address - Country:US
Mailing Address - Phone:561-758-8867
Mailing Address - Fax:
Practice Address - Street 1:2409 SE PASCAL AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6760
Practice Address - Country:US
Practice Address - Phone:561-758-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL540034207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services